Individual
JAN KENNETH GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
4251 NW AMERICAN LN, LAKE CITY, FL 32055-8844
(386) 758-6143
Mailing address
4245 METRON DR, JACKSONVILLE, FL 32216-1012
(386) 438-4142
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN11008439
FL
Other
Enumeration date
08/02/2020
Last updated
08/02/2020
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